National Institute on Drug Abuse Community Epidemiology Work Group (CEWG) NIDA Community Epidemiology Work Group 62 nd Semi- Annual Meeting June 2007 Seattle Honolulu Jim Hall Center for the Study and Prevention of Substance Abuse Nova Southeastern University Davie, Florida USA San Francisco Denver Los Angeles Phoenix San Diego Minneapolis/St. Paul Texas Boston Detroit New York Chicago Baltimore Philadelphia St. Louis D.C. Atlanta Miami/ Ft. Lauderdale
United States Department of Health and Human Services National Institutes of Health (NIH) National Institute on Drug Abuse (NIDA) Division of Epidemiology Services and Prevention Research (DEPAR) Community Epidemiology Work Group (CEWG)
United States Department of Health and Human Services National Institutes of Health (NIH) National Institute on Drug Abuse (NIDA) Division of Epidemiology Services and Prevention Research (DEPAR) Community Epidemiology Work Group (CEWG) National Institute on Alcohol Abuse and Alcoholism (NIAAA) Substance Abuse and Mental Health Services Administration (SAMHSA) Office Of Applied Studies (OAS)
NIDA Community Epidemiology Work Group Seattle Minneapolis/St. Paul Honolulu San Francisco Denver Los Angeles Phoenix San Diego Texas Detroit Chicago Baltimore D.C. St. Louis Atlanta Boston New York Philadelphia Miami/ Ft. Lauderdale
National Institute on Drug Abuse Community Epidemiology Work Group (CEWG) NIDA Community Epidemiology Work Group 62 nd Semi- Annual Meeting June 2007 Seattle Minneapolis/St. Paul Established 1976 Community Correspondents Group Heroin Focused Honolulu San Francisco Denver Los Angeles Phoenix San Diego Texas Boston Detroit New York Chicago Baltimore Philadelphia St. Louis D.C. Atlanta Miami/ Ft. Lauderdale
NIDA Community Epidemiology Work Group 62 nd Semi-Annual Meeting June 2007 Seattle Honolulu San Francisco Denver Los Angeles Phoenix San Diego Minneapolis/St. Paul Texas Boston Detroit New York Chicago Baltimore Philadelphia St. Louis D.C. Atlanta Miami/ Ft. Lauderdale Mission: Monitor Drug Abuse Trends by Tracking Existing Data Sources Within and Across 22 Local Areas in USA
NIDA Community Epidemiology Work Group 62 nd Semi-Annual Meeting June 2007 Seattle Honolulu San Francisco Denver Los Angeles Phoenix San Diego Minneapolis/St. Paul Texas Boston Detroit New York Chicago Baltimore Philadelphia St. Louis D.C. Atlanta Miami/ Ft. Lauderdale Goals: To Characterize Changes in Drug Use To Provide Early Identification of New Patterns and Emerging Drug Abuse issues
CEWG Meets Twice A Year June Meeting 3 ½ Days January Meeting 2 ½ Days Location Rotates among the 19 Sentinel Cites
Each CEWG Member Prepares 15-20 Page Written Report 20 Minute Presentation
CEWG Area Reports Format Organized By Drug Cocaine, Heroin, Rx Opiates, Methamphetamine, Marijuana, MDMA & Club Drugs, Benzodiazepines
CEWG Area Reports Format By Indicators (Consequences) Deaths, Emergency Department Reports Addiction Treatment Admissions, Price and Purity, Crime Lab Cases, and Prevalence Surveys Infectious Diseases
CEWG Meeting Agenda 22 Community Presentations: 1½1 days Regional Discussions Specific Drugs and Special Topics Discussion Panel: Emerging issues from previous CEWG meeting Panel: Host city researchers Update on Federal data sets Patterns & trends in other countries
Most Current Publication NIDA CEWG January 2007 Volume I Highlights and Executive Summary Volume II Community Reports Online at http://www.drugabuse.gov/pubs
NIDA Community Epidemiology Work Group 62nd Semi-Annual Meeting June 2007 Seattle Minneapolis/St. Paul Honolulu San Francisco Denver Los Angeles Phoenix San Diego Texas Detroit Chicago Baltimore D.C. St. Louis Atlanta Boston New York Philadelphia Miami/ Ft. Lauderdale
CEWG Highlights June 2007 Polysubstance Abuse Major Emerging Trend Fueled by Nonmedical Use of Rx Drugs Halt in Escalation of Methamphetamine Cocaine: Low Prevalence, High Consequences Heroin Indicators Down Replaced by Rx Opiates Marijuana: #1 Prevalence, #2 Consequences Ecstasy (MDMA) Rising after Decline Since 2001
Secondary Drugs of Abuse Among Primary Cocaine, Heroin, and Marijuana Admissions 2006 100% 80% 60% 40% 20% Cocaine Other None Marijuana Alcohol Heroin 0% Primary Cocaine Primary Heroin Primary Marijuana Source: New York State OASAS
Cocaine-Related Deaths in Florida 1991-2006 2000 1500 1000 Florida Miami-Dade 500 Broward 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Source: FDLE Florida Medical Examiners Commission Report 2006
Polysubstance Use Among State of Florida Cocaine-Related Deaths 2001-2006 2000 1500 1000 Cocaine Plus 500 0 Cocaine Only 2001 2002 2003 2004 2005 2006 Cocaine Plus 801 942 1142 1269 1443 1520 Cocaine Only 304 365 472 433 500 532 SOURCE: Florida Dept. of Law Enforcement, Florida Medical Examiners Commission Reports 2001-2006
Alcohol and other Drugs Detected in Cocaine-Related Deaths in Florida during 2005 n= 1,943 Plus Other Drug but no Alcohol 37% Plus Alcohol & Other Drug 16% Only Cocaine 26% Plus Only Alcohol 21% 52 % of Cocaine Deaths with Rx Medicine Source: Florida Medical Examiners Commission 2005
Opiate Medical Examiner Mentions in Florida 2000-2006 3000 2500 2000 1500 1000 Heroin 1,314 869 3 Rx Opiates 1,699 2,155 1,812 3 Rx Opiates 2,308 2,628 The 3 Rx Opiates are Methadone, Hydrocodone, and Oxycodone 500 0 276 328 326 261 180 Heroin 122 96 2000 2001 2002 2003 2004 2005 2006 Source: FDLE Florida Medical Examiners Commission Reports 2000-2006
Deaths per 100,000 persons 12 10 8 6 4 2 0 Rates of Unintentional Prescription Drug Overdose Death, New Mexico, 1990-2006 1990 1991 1992 Specific drugs are not mutually exclusive 1993 1994 1995 1996 1997 1998 1999 Any Rx drug Opioid other than methadone Antidepressant Source: The New Mexico Office of the Medical Investigator Rates are age-adjusted to the 2000 US Standard Population. 2000 2001 2002 2003 2004 2005 2006 Methadone Tranquilizer/muscle relaxant
Most common combinations of drugs in decedents 2000 through 2006 - Philadelphia 300 250 200 247 179 150 100 141 50 0 76 '00 '01 '02 '03 '04 '05 '06 cocaine + alcohol heroin + fentanyl cocaine + heroin heroin + alcohol Source: Philadelphia Medical Examiner s Office
Number of deaths with select Narcotic Analgesics by year Detroit, Michigan 250 200 150 100 50 0 1998 1999 2000 2001 2002 2003 2004 2005 2006 Fentanyl Hydrocodone Oxycodone Methadone
Nonprescription fentanyl-related poisoning deaths in Chicago, April 05 March 07 50 45 40 35 30 25 20 15 10 5 0 Apr-05 Jun-05 Aug-05 Oct-05 Dec-05 Feb-06 Apr-06 Jun-06 Aug-06 Oct-06 Dec-06 Feb-07 Deaths Source: Cook County Medical Examiner
Trends in Los Angeles County Treatment Admissions by Primary Substance of Abuse Percent (%) of all Admissions 50 40 30 20 10 0 2H00 1H01 2H01 1H02 2H02 1H03 2H03 1H04 2H04 1H05 2H05 1H06 Alcohol Cocaine/Crack Heroin Marijuana Methamphetamine SOURCE: LA County ADPA, California Outcome Monitoring System (CalOMS), 2007.
Changes in Race/Ethnicity Among 1 1 Meth Tx Admissions: 1999-1H 1H 2006 100 80 26% 54% 60 40 20 62% 36% 0 1999 2000 2001 2002 2003 2004 2005 1H2006 White (Not Hispanic) Hispanic Asian/Pacific Islander Black (Not Hispanic) American Indian/Alaska Native Other SOURCE: ADP, California Alcohol and Drug Data System, 1999-2006.
Meth Clandestine Lab Incidents in Southern States (1999-2006) 1400 1200 1000 800 600 400 200 0 Tn Ark LA MS AL GA Fl SC NC CY 1999 CY 2000 CY 2001 CY 2002 CY 2003 CY 2004 CY 2005 CY 2006 Source: National Clandestine Laboratory Database
10000 Cocaine Indicators in Texas: 1998-2006 1998 1999 2000 2001 2002 2003 2004 2005 2006 1000 100 10 1 PCC Calls Treatment DPS Labs Deaths % Pure
MDMA Indicators ecstasy Rising 2006 Reversing dramatic decline since 2001 Florida Deaths Up 148 % from 27 in 2005 to 67 in 2006 Up in Atlanta, Chicago, Miami, Texas Asian traffickers from Canada More African-Americans & Hispanics MDMA frequently adulterated with methamphetamine or other drugs NIDA Community Epidemiology Work Group Seattle Honolulu San Francisco Denver Los Angeles Phoenix San Diego Minneapolis/St. Paul Austin Detroit Chicago St. Louis New Orleans Atlanta D.C. Boston New York Newark Philadelphia Miami/ Ft. Lauderdale
Epidemiology Workgroups Provide Information for Action Monitor, evaluate, and improve plan and activities SAMHSA s Strategic Prevention Framework Steps Profile local drug abuse, resources, and readiness to address needs Sustainability & Cultural Competence Mobilize and/or build capacity to address needs Implement programs and activities Develop a Comprehensive Strategic Plan
Upfrontin@aol.com Center for the Study and Prevention of Substance Abuse Nova Southeastern University 69
Drug Use Surveys and other Data Sets in the United States
National Survey on Drug Use and Health (NSDUH) 2002-2006 2006 Population Aged 12 and Above Previously the National Household Survey on Drug Use (NHSDU) 1965-2001 Substance Abuse and Mental Health Services Administration Office of Applied Studies 35
Other Surveys Youth Risk Behavior Surveillance Survey High School Students (Grades 9-12) 9 Center for Disease Control and Prevention USA, States, Municipalities Monitoring the Future Survey National School Survey (Grades 8, 10, 12 th ) National Institute on Drug Abuse (NIDA) Florida Youth Substance Abuse Survey (Grades 6-12) State and Counties
Current Alcohol Use Among Americans Aged 12 and Above 126 Million 51.8 % 60.5 million smoke cigarettes Source: NSDUH 2005 25 %
Current Alcohol Use Among Americans Aged 12 and Above 125,309,000 50.9 % 61,565,000 smoke cigarettes Source: NSDUH 2006 25 %
Current Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2005 n= 19,700,000 People Percent Using in Past Month 9.0 8.0 7.0 8.1 6.0 Source: 2005 NSDUH 6.0 5.0 4.0 3.0 2.6 2.0 1.0 0.0 Any Drug 1.0 0.4 0.3 Marijuana Psychotherapeutics Cocaine Hallucinogens Inhalants
Current Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2006 n= 20,400,000 People Percent Using in Past Month 9.0 8.0 7.0 8.3 6.0 Source: 2006 NSDUH 6.0 5.0 4.0 3.0 2.8 2.0 1.0 0.0 Any Drug 1.0 0.4 0.3 Marijuana Psychotherapeutics Cocaine Hallucinogens Inhalants
Sub State Data 2002-2004
NSDUH Sub-State Data in Florida by 16 District
Misuse & Abuse of Medicine 7,872,000 Americans are Current Non-Medical Users of Prescription & OTC drugs. Source: USDHHS: SAMHSA- OAS 2005 National Survey on Drug Use and Health
Past 30 day Non-Medical Use of Pharmaceuticals 4,700,000 Pain Relievers 1,800,000 Tranquilizers 1,100,000 Stimulants 272,000 Sedatives Source: USDHHS: SAMHSA- OAS 2005 National Survey on Drug Use and Health
Past 30 day Non-Medical Use of Pharmaceuticals 5,220,000 Pain Relievers 1,766,000 Tranquilizers 1,191,000 Stimulants 385,000 Sedatives Source: USDHHS: SAMHSA- OAS 2006 National Survey on Drug Use and Health
Any Lifetime Non-Medical Use of Pain Relievers 2002 2005 29,600,000 32,700,000 Source: SAMHSA-OAS National Survey on Drug Use and Health
Any Lifetime Non-Medical Use of Pain Relievers 2002 2006 29,600,000 33,472,000 Source: SAMHSA-OAS National Survey on Drug Use and Health
Past Year Illicit Drug Use: 2005 #1 Marijuana #2 Rx Pain Med 25,500,000 11,300,000 Source: SAMHSA-OAS National Survey on Drug Use and Health
Past Year Illicit Drug Use: 2006 #1 Marijuana #2 Rx Pain Med 25,378,000 12,649,000 Source: SAMHSA-OAS National Survey on Drug Use and Health
Past Month Non-Medical Use of Rx Drugs by Young Adults Age 18-25 6.4% 6.2% 6.0% 5.8% 5.6% 5.4% 5.2% 5.0% 4.8% 6.3% 6.4% 6.1% 6.0% 5.4% 2002 2003 2004 2005 2006 Source: SAMHSA-OAS National Survey on Drug Use and Health
Incidence of Substance Abuse
First Time Drug Users: 2005 #1 Rx Pain Relievers* 2,200,000 * Includes 526,000 OxyContin @ #2 Marijuana 2,100,000 #3 Rx Tranquilizers 1,286,000 #4 Cocaine 872,000 Source: SAMHSA-OAS National Survey on Drug Use and Health
First Time Drug Users: 2006 #1 Rx Pain Relievers* 2,150,000 * Includes 533,000 OxyContin @ #2 Marijuana 2,063,000 #3 Rx Tranquilizers 1,112,000 #4 Cocaine 977,000 Source: SAMHSA-OAS National Survey on Drug Use and Health
Method of Obtaining Rx Pain Relievers Among Young Adult Abusers or Addicts Age 18-25 Source: SAMHSA-OAS National Survey on Drug Use and Health 2005
Dependence or Abuse of Specific Illicit Drugs among Persons Aged 12 or Older: 2005 Rx Drug 2,062 Cocaine Stimulants Hallucinogens Heroin Inhalants 409 371 227 221 1,549 Rx = 2,062,000 Source: NSDUH 0 500 1,000 1,500 2,000 2,500 Numbers (in Thousands) of Users with Dependence or Abuse
Dependence or Abuse of Specific Illicit Drugs among Persons Aged 12 or Older: 2006 Rx Drug 2,035 Cocaine Stimulants Hallucinogens Heroin Inhalants 390 380 323 176 1,671 Rx = 2,035,000 Source: NSDUH 0 500 1,000 1,500 2,000 2,500 Numbers (in Thousands) of Users with Dependence or Abuse
Past Year Use of Tranquilizers by 8th, 10th, and 12th Graders 1976-2006 12 % Source: NIDA: Monitoring the Future Survey 6 % 1976 2006
Past Year Use of Rx Narcotics by 12th Graders 1976-2006 Source: NIDA: Monitoring the Future Survey 8 % 4 % 1976 2006
Percent of High School Students Reporting Alcohol Use 2005 80.0% 70.0% 60.0% 50.0% United States State of Florida Broward County Miami- Dade County Palm Beach County 40.0% 30.0% 20.0% 10.0% 0.0% Any lifetime use Use in past 30 days Binge drinking last 30 days Source: Center for Disease Control and Prevention Youth Risk Behavior Survey 1993-2005
Percent Reporting First Use of Alcohol Before the Age of 13 Years Among High School Students USA, Florida, & Miami-Dade County % Reporting Use 29 28 27 26 28.9 25.6 25.4 27.9 25.4 USA Florida Miami-Dade Broward 25 Palm Beach 24 23 Before 13 Yrs Source: US Dept. of HHS Centers for Disease Control & Prevention 2005 Youth Risk Behavior Surveillance Survey
% Miami-Dade HS Students Reporting Alcohol Behaviors 40 1st Drink Before Age 13 Drank at school past 30 days Rode with driver who drank past 30 days Drove after drinking past 30 days % HS Students Reporting 35 30 25 20 15 10 5 0 1993 1995 1997 1999 2001 2003 2005 Source: Center for Disease Control and Prevention Youth Risk Behavior Survey 1993-2005
Cocaine Heroin Rx Pain Florida School Survey Middle and High School Current Use Methamphetamine Marijuana Current Use Source: Florida Youth Substance Abuse Survey 2006 2006 1.6 % 0.4 % 3.2 % 0.7 % 11.4 Change '00-'06* '06* -20 % -50 % -99 % -56 % -21 % Change 05-0606 +45 % +33 % +14 % 0 +10 % MDMA 1.2 % -57 % +20 % Depressant "Xanax" 2.5 % -14 % +14 % Alcohol 32.% -77 % +4 %
USA Treatment Admissions By Primary Drug 1992-2004 Percent of all Admits 13 % Heroin 14.2 % 0.8 % Rx Opiates N= 60,017 3.2 % 1992 2004 Source: SAMHSA, OAS Treatment Episode Data Sets (TEDS) 2004
Cocaine Treatment Admission Trends by Gender, Race, Age, & ROA (2002-2006*) 2006*) 70 60 50 40 30 20 10 0 2002 2003 2004 2005 2006* 80 70 60 50 40 30 20 10 0 White African- American Hispanic Other Male Female 2002 2003 2004 2005 2006* 90 80 70 60 50 40 30 20 10 0 0 to 17 18 to 25 26 to 34 35 and older 2002 2003 2004 2005 2006* 90 80 70 60 50 40 30 20 10 0 Smoking Sniffing IV Oral 2002 2003 2004 2005 2006* Source: Georgia Dept. of Human Resources
Criminal Justice Status for Primary Cocaine, Heroin, and Marijuana Admissions: 2006 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Cocaine N=17,328 Heroin N=21,973 Marijuana N=16,113 Some Criminal Justice Status No Criminal Justice Status Source: New York State OASAS
Cocaine and Heroin Positive NFLIS Items Higher Locally than U.S., but Methamphetamine Higher for U.S. 45 40 35 30 25 % 20 15 10 5 0 Cocaine Cannabis Heroin Meth. PCP Other Baltimore Washington U.S. SOURCE: NFLIS 2007; Baltimore N=51,242; Washington, D.C. N=4,468; U.S. N=1,421,902
80% Percentage of Washington, D.C., Adult Arrestees Testing Positive for Any Drug, Cocaine, PCP, and Opiates: 1984-2007* 70% 60% 50% Any Positive 40% Cocaine 30% 20% 10% PCP Opiates 0% 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 SOURCE: Adapted by CESAR from data from the District of Columbia Pretrial Services Agency. *NOTE: 2007 includes January-April.
Percentage of Washington, D.C., Juvenile Arrestees Testing Positive ive for Any Drug, Cocaine, PCP, and Marijuana: 1987-2007* 80% 70% 60% 50% Any Positive Marijuana 40% 30% 20% 10% Cocaine 0% PCP 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 SOURCE: Adapted by CESAR from data from the District of Columbia Pretrial Services Agency. NOTE: Any Positive includes opiates from 1987 through mid 1994 (< 1%). *2007 includes January-April.
Prescription Drug Sales 1997-2004 35 mill Oxycodone 20 mill Hydrocodone 5 mill Methadone 1997 2004 Source: DEA Automation of Reports and Consolidated Orders System (ARCOS)
Cheese Heroin Cheese is heroin & Tylenol PM, but now mentions of Advil, Nytol, and other PM products, as well as Xanax combination. Young Hispanic youths in Dallas, but may spread. Culturally relevant education & intervention needed. Couple of mentions elsewhere in the state. Death data varies: ME v. newspaper. Emphasize HEROIN,, not Cheese.
CHEESE HEROIN